Ask one of our plastic surgeons

Have a question about plastic surgery? Ask one of our Scripps Clinic plastic surgeons. From November 1-15, we invite you to submit your plastic surgery questions to our plastic surgeons. Your question will be answered within 48 hours.

You can submit your questions via Twitter ( twitter.com/scrippshealth) or post it on our Facebook page (facebook.com/scrippshealth).

Question: If I have spider veins that are obvious in my face, is it a plastic surgeon that either lasers them or injects them with something or a different doctor that I should go to?

Answer: Spider veins are difficult to make recommendations on without seeing them first. Depending on the location and prominence of the spider veins, there may be both non-surgical or surgical options to address this including lasers, intense pulsed light devices, and/or sclerotherapy, which involves injection techniques. There may be a combination of techniques used and it could take several sessions to reduce the look of spider veins. Some dermatologists do address spider veins, though if they are prominent, you may want to talk to a board certified plastic surgeon about surgical options.

Answer provided by Salvatore Pacella, MD

Question: I have very dark circles under my eyes, I have tried lots of creams with no results; it’s there a surgical procedure to correct that, or some treatment that can improve the skin tone.

Answer: There are several procedures to improve the dark circles under your eyes. Often, these circles are not necessarily caused by skin pigmentation, but are a result of the physics of how light shines on the lower eyelid. Specifically, if there is an excess of fatty tissue or a deep groove in the lower eyelid (commonly referred to as a “tear-trough”). Ambient light can create a very non-flattering shadow in the region, making it appear as a bulge or a dark circle. Several rejuvenating procedures can effectively re-contour this area to prevent this shadowing. The addition of some bleaching creams once the surgery is performed can also assist. A board certified plastic surgeon can assist you with deciding if these techniques are right for you. As a fellowship trained surgeon specializing in the eyelid, I have a very unique interest in this area.

Answer provided by Salvatore Pacella, MD

Question: What’s a good way to remove a non-cancerous mole from the chest of a woman? It’s about 1 inch lateral of the sternum on the right side, and 2 inches below the clavicle. It’s in a fatty area, but not in breast tissue.

Answer: Moles, particularly non-cancerous ones, can easily be removed with a small surgical procedure. The most important concept here is that any mole removed from the body should be examined microscopically for the presence of a possible skin cancer. It is not uncommon for a skin cancer to arise from a mole, and only to be found after the pathology is examined. In the office, a small amount of local anesthesia is used, and the mole can be removed surgically. Extremely fine suturing techniques are utilized to prevent excessive scarring and make the incision line heal as inconspicuously as possible. As a board certified plastic surgeon, I would advise against “shaving” a mole off. This will remove it effectively, but often the scarring is quite noticeable compared to a fine, thin incision line.

Answer provided by Salvatore Pacella, MD

Question: I’ve been hearing a lot lately about noninvasive RF “skin tightening,” which hypothetically melts fat under the skin and after a series of treatments results in tighter skin and more collagen with fewer bumps and bags.

I realize you’re a surgeon, but it’s not quite so bad that I need something quite that drastic yet. My question is, are these nonsurgical treatments (like Exilis) effective for things like jowls, turkey-neck, and/or double-chin? Or are they just wallet-draining marketing hype?

Answer: Some imperfections can improve subtly with non-invasive surgical treatments, but at times, knowing just who may benefit can be unpredictable. I will say that in general when there is skin laxity (i.e. excess skin), non-surgical treatments can be very disappointing. Over the last few years, many new minimally invasive surgical techniques have been developed. These can involve very small incisions and minimal downtime. In addition, many of the issues you describe can be addressed with soft-tissue fillers or Botox® injections. Your board-certified plastic surgeon can assist you in determining if you are a candidate for any of these minimally invasive techniques or treatments.

Answer provided by Salvatore Pacella, MD

Question: I have seriously considered getting an eyelid lift. My eyes feel heavy and tired. I am not sleep deprived but notice a definite difference when I just manually “lift” my eyes. What is involved in this type of surgery, recovery, etc.? Also, is it a procedure that is covered by insurance?

Answer: If you’ve had a documented visual field test that shows that your vision is affected by your eyelids, the eyelid procedure—called plastic blepharoplasty—can sometimes be covered by insurance. This procedure is done simply to see better and is not necessarily the same procedure performed to rejuvenate the look of the eyes as in cosmetic blepharoplasty. A board certified plastic surgeon can help you determine what type of surgery would be the most appropriate and whether it can be covered by insurance. The recovery for either type of eyelid lift can involve some mild swelling for 1-2 weeks and is usually tolerated well.

Answer provided by Salvatore Pacella, MD

Question: How much would corrective surgery cost on breast implants and can they go in through the same scar?

Answer: The answer truly depends on the work that needs to be done. Some breast revisional surgery is fairly complex and may require implant replacement, scar revision and operative time. Other surgery may be more straight forward. The price range may be variable but possibly in the $6,500 to $9,000 range. The best way to determine this is to have a visit with your board certified plastic surgeon. He or she can determine exactly what may need to be corrected.

Answer provided by Salvatore Pacella, MD

Note: Answers do not constitute official, individualized medical advice. Please see your doctor for important medical questions.

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